Pneumonia

Betty was admitted at the community hospital for a week because of acute gastroenteritis and was discharged last Monday. On Thursday, her mother noticed that her 9-year old is breathing faster than she normally does. She is also very warm to touch and is complaining of chest pain. On Saturday, she began spitting out greenish sputum.

Pathophysiology

Having an idea about the disease process helps the patient understand the treatment regimen and its importance, increasing patient compliance.

Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx.

An inflammatory reaction may occur in the alveoli, producing exudates that interfere with the diffusion of oxygen and carbon dioxide.

White blood cells also migrate into the alveoli and fill the normally air-filled spaces.

Due to secretions and mucosal edema, there are areas of the lung that are not adequately ventilated and cause partial occlusion of the alveoli or bronchi.

Hypoventilation may follow, causing ventilation-perfusion mismatch.

Venous blood entering the pulmonary circulation passes through the under ventilated areas and travels to the left side of the heart deoxygenated.

The mixing of oxygenated and poorly oxygenated blood can result to arterial hypoxemia.

Epidemiology

Pneumonia has affected a lot of people, especially those who have a weak immune system. Learning statistics on pneumonia could give you an idea about how many has fallen victim to this respiratory disease.

Pneumonia and influenza account for nearly 60,000 deaths annually.

Pneumonia also ranks as the eighth leading cause of death in the United States.

It is estimated that more than 915, 000 episodes of CAP occur in adults 65 years old and above in the United States.

HAP accounts for 15% of hospital-acquired infections and is the leading cause of death in patients with such infections.

The estimated incidence of HAP 4 to 7 episodes per 1000 hospitalizations.

Causes

Each type of pneumonia is caused by different and several factors.

Community-Acquired Pneumonia

Streptococcus pneumoniae. This is the leading cause of CAP in people younger than 60 years of age without comorbidity and in those 60 years and older with comorbidity.

Haemophilus influenzae. This causes a type of CAP that frequently affects elderly people and those with comorbid illnesses.

Mycoplasma pneumoniae.

Hospital-Acquired Pneumonia

Staphylococcus aureus. Staphylococcus pneumonia occurs through inhalation of the organism.

Impaired host defenses. When the defenses of the body are down, several pathogens may invade the body.

Comorbid conditions. There are several conditions that lower the immune system, causing bacteria to pool in the lungs and eventually result in pneumonia.

Supinepositioning. When the patient stays in a prolonged supine position, fluid in the lungs pools down and stays stagnant, making it a breeding place for bacteria.

Prolonged hospitalization. The risk for hospital infections or nosocomial infections increases the longer the patient stays in the hospital.

Clinical Manifestations

Pneumonia varies in its signs and symptoms depending on its type but it is not impossible to diagnose a specific pneumonia through its clinical manifestations.

Rapidly rising fever. Since there is inflammation of the lung parenchyma, fever develops as part of the signs of an infection.

Pleuritic chest pain. Deep breathing and coughing aggravate the pain in the chest.

Rapid and bounding pulse. A rapid heartbeat occurs because the body compensates for the low concentration of oxygen in the body.

Tachypnea. There is fast breathing because the body tries to compensate for the low oxygen concentration in the body.

Purulent sputum. The sputum becomes purulent because of the infection in the lung parenchyma which produced sputum-filled with pus.

Prevention

It is better to prevent the occurrence of pneumonia instead of treating the disease itself. Here are several ways that can help prevent pneumonia.

Pneumococcal vaccine. This vaccine can prevent pneumonia in healthy patients with an efficiency of 65% to 85%.

Infection and microbiologic surveillance. It is important to carefully observe the infection so that there could be an appropriate application of prevention techniques.

Modifying host risk for infection. The infection should never be allowed to descend on any host, so the risk must be decreased before it can affect one.

Complications

Pneumonia has several complications if left untreated or the interventions are inappropriate. These are the following complications that may develop in patients with pneumonia.

Shock and respiratory failure. These complications are encountered chiefly in patients who have received no specific treatment and inadequate or delayed treatment.

Pleural effusion. In pleural effusion, the fluid is sent to the laboratory for analysis, and there are three stages: uncomplicated, complicated, and thoracic empyema.

Assessment and Diagnostic Findings

Assessment and diagnosis of pneumonia must be accurate since there are a lot of respiratory problems that have similar manifestations. The following are assessments and diagnostic tests that could determine pneumonia.

History taking. The diagnosis of pneumonia is made through history taking, particularly a recent respiratory tract infection.

Physical examination. Mainly, the number of breaths per minute and breath sounds is assessed during physical examination.

Medical Management

The management of pneumonia centers is a step-by-step process that zeroes on the treatment of the infection through identification of the causative agent.

Blood culture. Blood culture is performed for identification of the causal pathogen and prompt administration of antibiotics in patients in whom CAP is strongly suspected.

Administration of macrolides.Macrolides are recommended for people with drug-resistant S. pneumoniae.

Hydration is an important part of the regimen because fever and tachypnea may result in insensible fluid losses.

Administration of antipyretics. Antipyretics are used to treat fever and headache.

Administration of antitussives. Antitussives are used for treatment of the associated cough.

Bed rest. Complete rest is prescribed until signs of infection are diminished.

Oxygen administration. Oxygen can be given if hypoxemia develops.

Pulse oximetry. Pulse oximetry is used to determine the need for oxygen and to evaluate the effectiveness of the therapy.

Aggressive respiratory measures. Other measures include administration of high concentrations of oxygen, endotracheal intubation, and mechanical ventilation.

Nursing Management

Nurses are expected to perform both dependent and independent functions for the patient to aid him or her towards the restoration of their well-being.

Nursing Assessment

Nursing assessment is critical in detecting pneumonia.

Assess respiratory symptoms. Symptoms of fever, chills, or night sweats in a patient should be reported immediately to the nurse as these can be signs of bacterial pneumonia.

Assess clinical manifestations. Respiratory assessment should further identify clinical manifestations such as pleuritic pain, bradycardia, tachypnea, and fatigue, use of accessory muscles for breathing, coughing, and purulent sputum.

Physical assessment. Assess the changes in temperature and pulse; amount, odor, and color of secretions; frequency and severity of cough; degree of tachypnea or shortness of breath; and changes in the chest x-ray findings.

Chest physiotherapy. Chest physiotherapy is important because it loosens and mobilizes secretions.

To promote rest and conserve energy:

Encourage avoidance of overexertion and possible exacerbation of symptoms.

Semi-Fowler’s position. The patient should assume a comfortable position to promote rest and breathing and should change positions frequently to enhance secretion clearance and pulmonary ventilation and perfusion.

To promote fluid intake:

Fluid intake. Increase in fluid intake to at least 2L per day to replace insensible fluid losses.

Practice Quiz: Pneumonia

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Practice Quiz: Pneumonia

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Congratulations - you have completed Practice Quiz: Pneumonia.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

CAP occurs either in the community setting or within the first _____ hours after hospitalization.

A

24.

B

48.

C

72.

D

36.

Question 1 Explanation:

CAP occurs either in the community setting or within the first 48 hours after hospitalization.

Question 2

HAP is the onset of pneumonia symptoms more than _____ hours after admission in patients with no evidence of infection at the time of admission.

A

72.

B

36.

C

48.

D

24.

Question 2 Explanation:

HAP occurs more than 48 hours after admission in patients with no evidence of infection at the time of admission.

Question 3

Which of the following is not considered as pneumonia in the immunocompromised host?

A

Nosocomial pneumonia.

B

Fungal pneumonia.

C

Pneumocystis pneumonia.

D

Mycobacterium tuberculosis.

Question 3 Explanation:

Nosocomial pneumonia is also known as hospital-acquired pneumonia and is not considered as pneumonia in the immunocompromised host.
Option B: Fungal pneumonia commonly occurs in patients who are immunocompromised.
Option C: Pneumocystis pneumonia is pneumonia in the immunocompromised host.
Option D: Mycobacterium tuberculosis is considered as pneumonia in the immunocompromised host.

Question 4

What is the most common form of aspiration pneumonia?

A

Fungal infection.

B

Bacterial infection.

C

Myocardial infarction.

D

Renal insufficiency.

Question 4 Explanation:

Bacterial infection from aspiration of bacteria that normally reside in the upper airways is the most common form of aspiration pneumonia.
Option A: Fungal infection can cause fungal pneumonia in the immunocompromised host.
Option C: Viral infection cannot cause aspiration pneumonia.
Option D: Renal insufficiency is not a nursing diagnosis.

Question 5

What is the leading cause of CAP?

A

S. aureus.

B

H. influenza.

C

E. coli.

D

S. pneumonia.

Question 5 Explanation:

S.pneumonia is the most common cause of CAP in people younger than 60 years old.
Option A: Aureus causes hospital-acquired pneumonia or HAP.
Option B: Influenza causes hospital-acquired pneumonia or HAP.
Option C: E.coli causes hospital-acquired pneumonia or HAP.

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Practice Quiz: Pneumonia

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Congratulations - you have completed Practice Quiz: Pneumonia.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

CAP occurs either in the community setting or within the first _____ hours after hospitalization.

A

24.

B

48.

C

72.

D

36.

Question 1 Explanation:

CAP occurs either in the community setting or within the first 48 hours after hospitalization.

Question 2

HAP is the onset of pneumonia symptoms more than _____ hours after admission in patients with no evidence of infection at the time of admission.

A

72.

B

36.

C

48.

D

24.

Question 2 Explanation:

HAP occurs more than 48 hours after admission in patients with no evidence of infection at the time of admission.

Question 3

Which of the following is not considered as pneumonia in the immunocompromised host?

A

Nosocomial pneumonia.

B

Fungal pneumonia.

C

Pneumocystis pneumonia.

D

Mycobacterium tuberculosis.

Question 3 Explanation:

Nosocomial pneumonia is also known as hospital-acquired pneumonia and is not considered as pneumonia in the immunocompromised host.
Option B: Fungal pneumonia commonly occurs in patients who are immunocompromised.
Option C: Pneumocystis pneumonia is pneumonia in the immunocompromised host.
Option D: Mycobacterium tuberculosis is considered as pneumonia in the immunocompromised host.

Question 4

What is the most common form of aspiration pneumonia?

A

Fungal infection.

B

Bacterial infection.

C

Myocardial infarction.

D

Renal insufficiency.

Question 4 Explanation:

Bacterial infection from aspiration of bacteria that normally reside in the upper airways is the most common form of aspiration pneumonia.
Option A: Fungal infection can cause fungal pneumonia in the immunocompromised host.
Option C: Viral infection cannot cause aspiration pneumonia.
Option D: Renal insufficiency is not a nursing diagnosis.

Question 5

What is the leading cause of CAP?

A

S. aureus.

B

H. influenza.

C

E. coli.

D

S. pneumonia.

Question 5 Explanation:

S.pneumonia is the most common cause of CAP in people younger than 60 years old.
Option A: Aureus causes hospital-acquired pneumonia or HAP.
Option B: Influenza causes hospital-acquired pneumonia or HAP.
Option C: E.coli causes hospital-acquired pneumonia or HAP.

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Text Mode:All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.

1. CAP occurs either in the community setting or within the first _____ hours after hospitalization.

A. 24.
B. 48.
C. 72.
D. 36.

2. HAP is the onset of pneumonia symptoms more than _____ hours after admission in patients with no evidence of infection at the time of admission.

A. 72.
B. 36.
C. 48.
D. 24.

3. Which of the following is not considered as pneumonia in the immunocompromised host?

I am always seen in bookstores trying to find peculiar books that tickle my senses and tear-jerker biographies. I prefer Maternal and Child Health Nursing and Medical-Surgical Nursing more than any other fields. I am always lusting after banana-infused food and beverages. I am currently in my second semester of my Master's in Nursing. And like everyone else, I love to swim at beaches and pools!